The Numbers

Anyone managing diabetes has heard about the importance of keeping track of "the numbers." These numbers are some key markers to help people with diabetes reduce their risk for complications from the disease. Most notably, they are LDL ("bad") cholesterol, blood pressure, and blood sugar. For most patients with diabetes, the goals are less than 100 mg/dl for LDL cholesterol, less than 130/80 mmHg for blood pressure, and less than 7 percent for A1C, which is a measure of average blood glucose over the past two to three months.

For many people, though, the numbers can become a source of stress. For one thing, no one wants to be thought of as just a set of numbers. But beyond that, people's reactions to these goals vary. Some people embrace the numbers and accept them as a personal challenge to achieve their goals. Others are ambivalent and put them on the back burner. Still others seem to become a little afraid of their numbers, partly fearing that they will be judged for not meeting desired targets. This can lead to deciding, "I'd rather just not know." And that can lead to the most dangerous number of all—the one that is unmeasured and unknown.

Well, for readers with diabetes and those of us who help take care of people with diabetes, let's briefly revisit the numbers and how to think about them in the context of helping people manage their diabetes.

New guidelines for blood glucose control in type 2 and an upcoming guideline on the comprehensive care of type 1 from the American Diabetes Association stress a patient-centered approach. The idea of more patient-centered care is absolutely the correct approach to managing diabetes. People come to providers at many different stages of readiness and willingness to work on different aspects of their condition. Getting ideal control over all your numbers can become its own 12-step program.

Health care providers need to assess what individuals' goals are and how ready and able they are to work toward them. We need to know if patients accept and understand that out-of-range blood sugars, blood pressure, and cholesterol are damaging. Are they ready to make changes in their lifestyle or take medications to get those risk factors under better control? If not, we need to know how we can work together to establish and reach health goals. Prescribing a long-term medication to a person who is unready or unwilling to take it treats the prescriber more than it treats the patient.

Yet, a patient-centered approach does not mean that we can relax our treatment goals for patients. General goals such as an A1C under 7 percent and an LDL cholesterol under 100 mg/dl are set for good reasons. Rather, a patient-centered approach is a reminder to all of us that the person with diabetes has to come before the numbers and that it is the caregiver's job to help patients understand and care about their own numbers as much as we do.